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The utility of 2-[18F]FDG-PET/CT maximum SUV versus CT attenuation for directing bone biopsies

  • Musculoskeletal
  • Published:
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Abstract

Objectives

This study aimed to compare the accuracy of PET/CT parameters with CT parameters for directing bone biopsies.

Methods

The study was an IRB-approved retrospective study of 388 patients who underwent both 2-[18F] FDG PET/CT and CT within 6 weeks before a bone biopsy. Age, sex, cancer type, lesion length, SUVmax, tumor to liver (T/L) ratio, CT attenuation, difference in CT attenuation between the lesion and normal bone (delta CT attenuation), and the absolute delta CT attenuation were used as predictors. T tests and chi-squared tests were used to compare variables. DeLong’s test was used to compare receiver operator characteristic (ROC) curves.

Results

We reviewed the data from 388 patients. Of these, 295 patients had bone lesion biopsies, and 93 patients had bone marrow aspirations/biopsies. Biopsies of larger bone lesions (p = 0.033) and bone lesions with higher SUVmax (p = 0.005) were more likely to show malignancy. For bone lesions, the ROC curve for the SUVmax (AUC = 0.6827) was better than the ROC curves for delta CT attenuation (AUC = 0.5766, p = 0.032) and absolute delta CT attenuation (AUC = 0.5491, p = 0.006), but not significantly better than the ROC curves for CT attenuation (AUC = 0.5894, p = 0.061) and T/L ratio (AUC = 0.6778, p = 0.774). A threshold SUVmax of 5.25 had an accuracy of 0.713, sensitivity of 0.766, and specificity of 0.549 to predict malignancy in bone lesion biopsies. None of these variables predicted malignancy in bone marrow biopsies (p > 0.05 for all).

Conclusions

Metabolic 2-[18F]FDG PET/CT parameters have more clinical impact for planning bone biopsies as compared to CT parameters.

Key Points

• The 2-[ 18 F]FDG PET/CT measurement (SUVmax) has more clinical impact for planning bone biopsies as compared to CT measurements.

• Neither the change in CT attenuation of the lesion relative to normal bone nor the absolute value of this change was a significant predictor of malignancy.

• 2-[ 18 F]FDG PET/CT may have clinical benefit and an additional role in directing bone biopsies.

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Abbreviations

2-[18F]FDG:

2-deoxy-2-[ 18F]fluoro-D-glucose

ABP:

American Board of Pathology

ABR:

American Board of Radiology

Absolute delta CT attenuation:

Absolute value of the Delta CT attenuation

AUC:

Area under the curve

CONSORT :

Consolidated Standards of Reporting Trials

CT :

Computed tomography

Delta CT attenuation:

CT attenuation of the lesion–CT attenuation of normal bone

EANM:

European Association of Nuclear Medicine

EMR:

Electronic medical record

HNSCC:

Head and neck squamous cell carcinoma

HU:

Hounsfield units

IRB:

Institutional review board

MDP:

Tc-99 m methylene diphosphonate

MRI:

Magnetic resonance imaging

PET/CT:

Positron emission tomography/computed tomography

ROC:

Receiver operator characteristic

SD:

Standard deviation

SUVmax :

Maximum standardized uptake value

T/L ratio:

Ratio of SUVmax of the lesion to the liver SUVmax

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Acknowledgements

RS was supported by R21 NIH/NIMH MH093415.

Funding

This study has received funding from the National Institutes of Health (NIH) Grant # R21 NIH/NIMH MH093415.

Author information

Authors and Affiliations

  1. Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Ronnie Sebro & S. Sharon Ashok

  2. Department of Orthopaedic Surgery, University of Pennsylvania, 3737 Market Street, Philadelphia, PA, 19104, USA

    Ronnie Sebro

  3. Department of Genetics, University of Pennsylvania, 421 Marie Curie Blvd, Philadelphia, PA, 19104, USA

    Ronnie Sebro

  4. Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, 423 Guardian Blvd, Philadelphia, PA, 19104, USA

    Ronnie Sebro

Authors
  1. Ronnie Sebro
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  2. S. Sharon Ashok
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Correspondence to Ronnie Sebro.

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Guarantor

The scientific guarantor of this publication is Ronnie Sebro, MD, PhD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise (PhD in Biostatistics).

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• observational

• multihospital study performed at one institution

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Sebro, R., Ashok, S.S. The utility of 2-[18F]FDG-PET/CT maximum SUV versus CT attenuation for directing bone biopsies. Eur Radiol 31, 6780–6792 (2021). https://doi.org/10.1007/s00330-021-07770-8

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  • DOI: https://doi.org/10.1007/s00330-021-07770-8

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